People Before Profits February 21 - 22, 2013
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Overdiagnosis and Overtreatment Over Time
University of Massachusetts Medical School eScholarship@UMMS Family Medicine and Community Health Publications and Presentations Family Medicine and Community Health 2015-6 Overdiagnosis and overtreatment over time Stephen A. Martin University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/fmch_articles Part of the Community Health and Preventive Medicine Commons, Diagnosis Commons, Family Medicine Commons, Preventive Medicine Commons, and the Primary Care Commons Repository Citation Martin SA, Podolsky SH, Greene JA. (2015). Overdiagnosis and overtreatment over time. Family Medicine and Community Health Publications and Presentations. https://doi.org/10.1515/dx-2014-0072. Retrieved from https://escholarship.umassmed.edu/fmch_articles/318 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Family Medicine and Community Health Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Diagnosis 2015; 2(2): 105–109 Opinion Paper Open Access Stephen A. Martin*, Scott H. Podolsky and Jeremy A. Greene Overdiagnosis and overtreatment over time Abstract: Overdiagnosis and overtreatment are often Introduction thought of as relatively recent phenomena, influenced by a contemporary combination of technology, speciali- In recent years, an increasing number of clinicians, jour- zation, payment models, marketing, and supply-related nalists, health service researchers, and policy-makers demand. Yet a quick glance at the historical record reveals have drawn attention to the problems of overdiagnosis that physicians and medical manufacturers have been and the overtreatment that it so often engenders [1, 2]. -
Pricing & Reimbursement
Pricing & Reimbursement 2018 First Edition Contributing Editor: Edward J. Dougherty CONTENTS Preface Edward J. Dougherty, Dentons US LLP General chapter Reimbursement of Specialty Drugs in the Hospital Inpatient Setting: Are current pathways in the USA and Europe sufficient? Stephen Hull & Claire Bezdek Gochal, Hull Associates LLC 1 Country chapters Angola Paulo Pinheiro, Francisca Paulouro & Pedro Fontes, Vieira de Almeida 16 Australia Greg Williams, Colin Loveday & Sheena McKie, Clayton Utz 23 Austria Francine Brogyányi & Bernhard Müller, DORDA Rechtsanwälte GmbH 36 Belgium Pieter Wyckmans & Julie De Keukeleire, Quinz 48 Brazil Rodrigo Augusto Oliveira Rocci, Dannemann Siemsen Advogados 61 Canada Sara Zborovski, Christopher A. Guerreiro & Ian Trimble, Norton Rose Fulbright Canada LLP 73 China Nicolas Zhu, CMS China 80 France Catherine Mateu, Armengaud Guerlain 87 Germany Dr. Ulrich Reese & Carolin Kemmner, Clifford Chance LLP 100 India Archana Sahadeva, Deepshikha Malhotra & Bitika Sharma, Singh and Singh Law Firm LLP 112 Ireland Marie Doyle-Rossi & Maree Gallagher, Covington & Burling LLP 122 Japan Chie Kasahara, Yuji Tomioka & Kirika Morita, Atsumi & Sakai 131 Mozambique Paulo Pinheiro, Francisca Paulouro & Pedro Fontes, Vieira de Almeida 138 Norway Sigrid Toft Fløystad & Per Thomas Thomassen, Advokatfirmaet Grette AS 144 Poland Agata Zalewska-Gawrych & Marta Skomorowska, Food & Pharma Legal Wawrzyniak Zalewska Radcy Prawni sp.j. 154 Portugal Paulo Pinheiro, Francisca Paulouro & Pedro Fontes, Vieira de Almeida 159 Romania Silvia Sandu, Bohâlțeanu și Asociații 170 Spain Jordi Faus & Mercè Maresma, Faus & Moliner 180 Sweden Odd Swarting & Camilla Appelgren, Calissendorff Swarting Advokatbyrå KB 192 Switzerland Dr. Oliver Künzler, Dr. Carlo Conti & Dr. Martina Braun, Wenger Plattner 202 United Kingdom Grant Castle & Brian Kelly, Covington & Burling LLP 210 USA Edward J. -
PRESCRIPTION DRUG COUPON STUDY Report to the Massachusetts Legislature JULY 2020
COMMONWEALTH OF MASSACHUSETTS HEALTH POLICY COMMISSION PRESCRIPTION DRUG COUPON STUDY Report to the Massachusetts Legislature JULY 2020 EXECUTIVE SUMMARY In this report, required by Chapter 363 of the 2018 Session Prescription drug coupons are currently allowed in all 50 Laws, the Massachusetts Health Policy Commission (HPC) states for commercially-insured patients. Federal health examines the use and impact of prescription drug coupons insurance programs, such as Medicare, Medicaid, Tricare in Massachusetts. This report focuses on coupons issued by and Veteran’s Administration, prohibit the use of coupons pharmaceutical manufacturers that reduce a commercial based on federal anti-kickback statutes. Massachusetts patient’s cost-sharing. Prescription drug coupons are offered became the last state to authorize commercial coupon use almost exclusively on branded drugs, which comprise only in 2012 but continues to prohibit manufacturers from 10% of all prescriptions dispensed in the U.S., but account offering coupons and discounts on any prescription drug for 79% of total drug spending. Despite the immediate ben- that has an “AB rated” generic equivalent as determined efit of drug coupons to patients, policymakers and experts by the Food and Drug Administration (FDA). The 2012 debate whether and how coupons should be allowed in the law authorizing coupons in Massachusetts also contained commercial market given the potential relationship between a sunset provision, under which the law would have been coupon usage and increased spending on branded drugs repealed on July 1, 2015. However, this date of repeal versus lower cost alternatives. was postponed several times and ultimately extended to January 1, 2021. Massachusetts has long sought to con- Coupons reduce or eliminate the patient’s cost-sharing sider the impact of drug coupons on the Commonwealth’s responsibility required by the patient’s insurance plan, while landmark cost containment goals, as well as the benefits for the plan’s costs for the drug remain unchanged. -
United States District Court for the Southern District of New York Filed Under Seal Pursuant to 31U.S.C. §3730 United States Of
Case 1:15-cv-07881-JMF Document 20 Filed 04/13/18 Page 1 of 267 UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF NEW YORK FILED UNDER SEAL PURSUANT TO 31U.S.C. §3730 UNITED STATES OF AMERICA, THE STATE OF CALIFORNIA, THE STATE OF COLORADO, THE STATE OF CONNECTICUT, CIVIL ACTION NO. THE STATE OF DELAWARE, THE STATE OF FLORIDA, THE STATE OF GEORGIA, THE STATE OF HAWAII, THE STATE OF RELATOR'S COMPLAINT PURSUANT TO ILLINOIS, THE STATE OF INDIANA, THE THE FEDERAL FALSE CLAIMS ACT [31 STATE OF IOWA, THE STATE OF LOUSIANA, U.S.C.§3729 et seq.]; AND SUPPLEMENTAL THE STATE OF MARYLAND, THE STATE OF STATE FALSE CLAIMS ACTS MASSACHUSETTS, THE STATE OF MICHIGAN, THE STATE OF MINNESOTA, THE STATE OF MONTANA, THE STATE OF NEVADA, THE STATE OF NEW HAMPSHIRE, THE STATE OF NEW JERSEY, THE STATE OF NEW MEXICO, THE STATE OF NEW YORK, THE STATE OF NORTH CAROLINA, THE STATE OF OKLAHOMA, THE STATE OF RHODE ISLAND, THE STATE OF TENNESSEE, THE STATE OF TEXAS, THE STATE OF VIRGINIA, THE STATE OF WASHINGTON, THE STATE OF WISCONSIN AND THE DISTRICT OF COLUMBIA, ex rel. JOHN R. BORZILLERI, M.D. Plaintiffs, ABBVIE, INC., AMGEN, INC., BRISTOL- MYERS SQUIBB COMPANY, JOHNSON & JOHNSON, ELI LILLY & COMPANY, NOVARTIS AG, PFIZER, INC., SANOFI S.A., UCB GROUP S.A., EXPRESS SCRIPTS HOLDING COMPANY, CVS CAREMARK CORPORATION, UNITEDHEALTH GROUP, INC., HUMANA, INC., ANTHEM (FORMERLY WELLPOINT), INC., CIGNA JURY TRIAL DEMANDED CORPORATION, AETNA, INC. AND WELLCARE HEALTH PLANS, INC. Defendants. 1 Case 1:15-cv-07881-JMF Document 20 Filed 04/13/18 Page 2 of 267 RELATOR’S COMPLAINT NATURE OF THE ACTION 1. -
Bluereviewsm
BLUE REVIEWSM A NEWSLETTER FOR MONTANA HEALTH CARE PROVIDERS SECOND QUARTER 2020 Inside This Issue COVID-19 Coverage .....................................................................2 Federal Agencies Extend Timely Filing and Medicare Advantage Recoupment Threshold to be Appeals Deadlines ........................................................................7 Implemented, Effective August 15, 2020 ...............................2 Montana Tobacco Quit Line Offers Increased Important Reminder Regarding Billing for Incentives for Pregnant Women .............................................11 Point-Of-Use Convenience Kits .................................................3 Healthy Montana Kids Durable Medical Equipment BlueCard® Alert: Prior Authorization Process Reimbursement Change Effective June 20, 2020 ..............11 for California Blue Plan Members With Prefix PHU ............4 NEWS ROOM Update: Change in Advance Member Notification BCBSMT Commits $150,000 to Montana Tech Process July 15, 2020 ...................................................................5 for Future Nursing Simulation Center............................... 12 Calls to Electronic Commerce Services Will $10,000 Contribution from BCBSMT to Aid PPE be Redirected to Email as of June 15, 2020 ..........................5 Production by Montana Manufacturers ...........................14 Remember to Use In-Network Laboratories ........................6 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective on or after July 1, 2020 – Part 1 ...........16 Medicare -
Alison Bass Curriculum Vitae Current Affiliations • Associate Professor Of
Alison Bass Curriculum Vitae Current Affiliations Associate Professor of Journalism, West Virginia University 2012-present Author, Freelance Writer and Blogger 2008-present Journalism Experience Author of forthcoming book, Getting Screwed: Sex Workers and the Law (Fall 2015) Getting Screwed takes a wide-ranging historic look at prostitution in the United States. It weaves the true stories of sex workers (past and present) together with the latest research in exploring the advisability of decriminalizing adult prostitution. To read more about this project, visit www.sexworkandthelaw.com/. Author of Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial Side Effects won the NASW Science in Society Award and garnered critical acclaim from many quarters, including The New York Review of Books, The Boston Globe and The Washington Post. Published by Algonquin Books in 2008, Side Effects tells the true story of three people who exposed the deception behind the making of a bestselling drug. To read more about the book, visit www.alison-bass.com. Journalist-Blogger 2008-present My blog, at http://www.sexworkandthelaw.com/blog/ is an ongoing discussion about sex work and public health. I have also written blogs for The Huffington Post and opinion pieces for The Boston Globe about various topics including scientific misconduct and sex work. Alicia Patterson Foundation 2007-2008 Won a prestigious Alicia Patterson Fellowship to write Side Effects, a book about scientific fraud and conflicts of interest in the medical/pharmaceutical industry. CIO magazine, Executive Editor 2000-2006 Wrote and edited feature-length articles and columns for CIO, an award-winning business magazine that covers information technology. -
BOOKTIVISM: the Power of Words
BOOKTIVISM: The Power of Words Book•ti•vi•sm(noun). 1. The mobilization of groups of concerned citizens produced by reading books offering powerful analyses of social or political issues. 2. A call to action based on the sharing of knowledge through books. 3. Books + activism = “booktivism.” 4. A term first used at the SellingSickness, 2013: People Before Profits conference in Washington, DC, see www.sellingsickness.com. Read. Discuss. Be thoughtful. Be committed. Here are some more suggestions to get you started: 1) Set up a reading group on disease-mongering among interested friends and colleagues. If you do The books included in BOOKTIVISM celebrate recent contributions to the broad topic of disease- not already have a group of interested readers, post a notice in your workplace, library, community mongering, especially as they examine the growing prevalence and consequences of overtreatment, center, apartment building, etc. Once you have a group, decide where to meet. Book clubs can overscreening, overmarketing, and overdiagnosis (see Lynn Payer’s 1992 classic, Disease-Mongers: How meet anywhere – at homes, in dorms, in pubs, in coffeehouses, at libraries, even online! Decide on Doctors, Drug Companies, and Insurers Are Making You Feel Sick, for an introduction to timing and format. Will you meet monthly/bimonthly? You’ll need time to prepare for the sessions, disease-mongering). but not so much time that you lose touch. Circulate the reading guide. It is usually best if one person leads each discussion, to have some questions at the ready and get things rolling. Although the challenge to disease-mongering is not unprecedented (the women’s health movement of the 1970s was another key historical moment), these books represent an impressive groundswell OR, maybe you’d like to of amazing, powerful, brilliant, and often deeply unsettling investigations by physicians, health scientists, 2) Set up a lecture/discussion group. -
Busniess ADVANTAGE Member Guide 2020
Focus on life. Focus on health. Stay focused. BusinessADVANTAGESM 2020 Member Guide Table of Contents Introduction . 1 Health Insurance Portability Your ID Card . 3 And Accountability Act (HIPAA) . 25 Advantages of Your Digital ID Card . 3 Authorization to Disclose to a Third Party Form . 26 How to Access Your Digital ID Card . 3 If You Need To See A Doctor . 27 Your Personal Physician . 27 Accessing the ADVANTAGE Network . 4 Routine Care . 27 ADVANTAGE Network Benefits . 4 Gynecologist (GYN) . 27 Transition of Care . 4 If You Need to See a Specialist . 27 Benefit Basics . 5 Other Health Care Providers . 27 At-a-Glance Charts . 5 If You Need Urgent Care . 28 Plan Overview . 7 Urgent Care . 7 If You Need To Be Admitted To A Hospital . 29 What We Pay For . 7 If You Need Emergency Care . 29 Out-of-Network Benefits . 7 When Is an Emergency Not an Emergency? . 30 What We Do Not Pay For . 8 Services and Supplies We Don’t Cover . 8 If You Need A Prescription Drug . 31 What Is the Covered Drug List? . 31 Preventive Care And How To Stay Healthy . 10 How We Cover Drugs on the Covered Drug List . 31 Coverage for Preventive Exams and Screenings . 10 Preventive Health Guidelines . 10 Can The Covered Drug List Change? . 33 What if My Drug Is Not on the Covered Drug List? . 33 Great Expectations® for health . 11 How to Enroll . 11 Additional Pharmacy Considerations . 33 How the Programs Work . 11 For More Information . 33 Benefits and Services . 13 If You Need Other Services . 33 Adult Vision Care . -
Trends and Effects of Pharmaceutical DTCA Alberto Coustasse Marshall University, [email protected]
Marshall University Marshall Digital Scholar Management Faculty Research Management, Marketing and MIS 2018 Trends and Effects of Pharmaceutical DTCA Alberto Coustasse Marshall University, [email protected] P. Sathorn William K. Willis Marshall University, [email protected] Follow this and additional works at: http://mds.marshall.edu/mgmt_faculty Part of the Health and Medical Administration Commons, and the Medical Specialties Commons Recommended Citation Sathorn, P., Willis W., & Coustasse, A. (2018). Trends and effects of pharmaceutical DTCA. International Journal of Pharmaceutical and Healthcare Marketing, 12(1), 61-70. This Article is brought to you for free and open access by the Management, Marketing and MIS at Marshall Digital Scholar. It has been accepted for inclusion in Management Faculty Research by an authorized administrator of Marshall Digital Scholar. For more information, please contact [email protected], [email protected]. TRENDS AND EFFECTS OF PHARMACEUTICAL DTCA ABSTRACT Purpose – The purpose of the review is to investigate the current trend of pharmaceutical Direct-to-Consumer Advertising (DTCA) in the US and its effect on patients, physicians, and drug utilization. DTCA by pharmaceutical firms may be defined as an attempt by pharmaceutical companies to advertise products directly to patients. Design/methodology/approach – Methodology for this paper is a literature review approach. Findings – Pharmaceutical DTCA demonstrated a reduction in total spending, while the online channel media experienced growth. DTCA has influenced the physician-patient relationship and patient satisfaction. Patients who received medication associated with DTCA showed higher satisfaction. DTCA of second-line drugs increased first-line drug utilization. Benefits of pharmaceutical DTCA include enhancing appropriate drug utilization and increasing awareness. -
The Failed Economics of Consumer- Driven Health Plans
The Failed Economics of Consumer- Driven Health Plans John Aloysius Cogan Jr.* Consumer-driven health plans (“CDHPs”) are now the dominant form of health insurance coverage in the US. CDHPs represent a market-based attempt to control health insurance costs. By requiring a significant outlay of the patient’s own money before insurance payments begin, CDHPs try to turn patients into health care consumers. Patients-turned-consumers, so the theory goes, will be more judicious about health spending and will reduce consumption of low-value health care. In response, health care providers will lower their prices to compete for fewer health care dollars. But the CDHP price-lowering theory is flawed. Constructed using an economism framework, CDHPs rely on a microeconomic, partial equilibrium model that overextends the concept of moral hazard and disregards the larger health care economy. This matters. CDHP theory simply ignores the powerful legal structures and system incentives that health care providers exploit to limit competition and drive up prices. In short, CDHPs cannot reduce prices because larger, more powerful profit-driven forces in our health care system out-muscle CDHP’s “patient power” approach to price control. This failure leaves patients with CDHPs in a dangerous double bind: they are increasingly burdened by high deductibles yet possess less purchasing power as medical prices keep rising. As a result, many patients with CDHPs suffer medical harm and are plunged into financial ruin. * Copyright © 2021 John Aloysius Cogan Jr. Associate -
National Cancer Institute University of Oxford
SEPTEMBER 1-3, 2015 CO-SPONSORED BY NATIONAL CANCER INSTITUTE Division of Cancer Prevention UNIVERSITY OF OXFORD Centre for Evidence-Based Medicine NATCHER CONFERENCE CENTER National Institutes of Health | Bethesda, Maryland USA NOTICE OF PHOTOGRAPHY & FILMING Preventing Overdiagnosis 2015 is being visually documented. By your attendance you acknowledge that you have been informed that you may be photographed and recorded during this event . Images taken will be treated as property of Preventing Overdiagnosis and may be used in the future for promotional purposes. These images may be used without limitation by any organisation approved by the Preventing Overdiagnosis scientific committee and edited prior to publication as seen fit for purpose. Images will be available on the Internet, accessible to Internet users throughout the world including countries that may have less extensive data protection laws than partnering organisation countries. All films will be securely stored on the University of Oxford servers. Please make your- self known at the registration desk if you wish to remain off camera. Thank you for your cooperation. CONFERENCE PARTNERS The Dartmouth Institute Bond University, Centre for Research in Evidence-Based Practice The BMJ Consumer Reports University of Oxford, Centre for Evidence-Based Medicine The views expressed in these materials or by presenters or participants at the event do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, the National Institutes of Health, the National Cancer Institute, or any NIH component. TABLE OF CONTENTS WELCOME 2015 Scientific Committee 4 KEYNOTES BIOS 6 PROGRAMME 16 KEYNOTE ABSTRACTS 32 WORKSHOP ABSTRACTS 34 SEMINAR ABSTRACTS 48 PANEL SESSION ABSTRACTS 61 POSTERS 66 NOTES 67 MAPS WELCOME We are pleased to welcome you to the 3rd Preventing Overdiagnosis conference, held in Bethesda, Maryland on the campus of the US National Institutes of Health. -
Quarterly Pharmacy Changes Effective Jan. 1, 2020 – Part 1
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2020 – Part 1 Posted November 1, 2019 PHARMACY NETWORK CHANGES Some Blue Cross and Blue Shield of Illinois (BCBSIL) members’ plans may experience changes to the pharmacy network beginning Jan. 1, 2020. Some members’ plans may move to a new pharmacy network and some members’ plans may experience changes to the pharmacies participating within the network. Based on claims data, members impacted by these changes were sent letters from BCBSIL to alert them. Members who continue to fill prescriptions at a pharmacy no longer in their network will pay more. In most cases, no action is required on your part for any of these pharmacy network changes as members can easily transfer prescriptions to a nearby in-network pharmacy. If your office stores pharmacy information on your patients’ records, you may want to ask your patient which pharmacy is their preferred choice. DRUG LIST CHANGES Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) will be made to the Blue Cross and Blue Shield of Illinois (BCBSIL) drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes. Changes effective Jan. 1, 2020 are outlined below. You can view a preview of the January drug lists on our Member Services website.